Payment and Medical Policy Coordinator (Remote)

CareFirst•Baltimore, MD

1d•Remote

About The Position

The Policy Coordinator will support the end-to-end implementation of medical and payment policies by coordinating cross-functional activities required to operationalize policy decisions. This role ensures business readiness across impacted functions, including claims, configuration, provider communications and operations, and provides support during testing, implementation, and post-implementation validation. We are looking for an experienced professional to work remotely from within the greater Baltimore/Washington metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities.

Requirements

Bachelor's Degree in Health Administration, Business, Finance or related discipline OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
Experience in health plan operations, project coordination, policy implementation, claims operations, or related functions.
Strong organizational and coordination skills across multiple teams and stakeholders.
Ability to manage multiple workstreams and meet deadlines.
Strong communication skills with ability to translate policy decisions into operational tasks
Working knowledge of managed care, claims processes, and policy implementation workflows.
Ability to identify risks, track issues, and escalate appropriately.
Use of Microsoft Office applications (Excel, PowerPoint, Word) and project tracking tools.
Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.
Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
Must be eligible to work in the U.S. without Sponsorship

Nice To Haves

Certified Coder (CCS or CPC)-AHIMA or AAPC AAPC Certified Professional Coder (CPC) or AHIMA Certified Coding Specialist (CCS).
Experience working in a health plan environment (Medical Policy, Payment Policy, Claims, or Operations).
Experience coordinating cross-functional projects or implementations.
Familiarity with claims systems, configuration processes, or policy governance.

Responsibilities

Coordinates cross-functional activities required to implement medical and payment policy changes, including alignment across claims, configuration, provider operations, network management, and compliance teams.
Tracks key milestones and ensures readiness for policy go-live.
Supports business readiness activities, including impact assessments, readiness checklists, and coordination of implementation plans.
Works with stakeholders to identify operational, staffing, and workflow impacts associated with policy changes.
Coordinates testing activities related to policy implementation, including user acceptance testing (UAT), validation of claims adjudication logic, and issue tracking/resolution.
Ensures testing results are documented and communicated to stakeholders.
Maintains implementation documentation, including timelines, status reports, risks, and dependencies.
Provides regular updates to leadership and ensures transparency across teams.
Supports post-implementation monitoring by coordinating issue tracking, identifying gaps in execution, and escalating risks or defects to appropriate stakeholders for resolution.